title: Demographic and clinical correlates of autism symptom domains and autism spectrum diagnosis.
abstract: Demographic and clinical factors may influence assessment of autism symptoms. This study evaluated these correlates and also examined whether social communication and interaction and restricted/repetitive behavior provided unique prediction of autism spectrum disorder diagnosis. We analyzed data from 7352 siblings included in the Interactive Autism Network registry. Social communication and interaction and restricted/repetitive behavior symptoms were obtained using caregiver-reports on the Social Responsiveness Scale. Demographic and clinical correlates were covariates in regression models predicting social communication and interaction and restricted/repetitive behavior symptoms. Logistic regression and receiver operating characteristic curve analyses evaluated the incremental validity of social communication and interaction and restricted/repetitive behavior domains over and above global autism symptoms. Autism spectrum disorder diagnosis was the strongest correlate of caregiver-reported social communication and interaction and restricted/repetitive behavior symptoms. The presence of comorbid diagnoses also increased symptom levels. Social communication and interaction and restricted/repetitive behavior symptoms provided significant, but modest, incremental validity in predicting diagnosis beyond global autism symptoms. These findings suggest that autism spectrum disorder diagnosis is by far the largest determinant of quantitatively measured autism symptoms. Externalizing (attention deficit hyperactivity disorder) and internalizing (anxiety) behavior, low cognitive ability, and demographic factors may confound caregiver-report of autism symptoms, potentially necessitating a continuous norming approach to the revision of symptom measures. Social communication and interaction and restricted/repetitive behavior symptoms may provide incremental validity in the diagnosis of autism spectrum disorder.
authors.affiliation: Cleveland Clinic, USA fraziet2@ccf.org.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Frazier
authors.affiliation: University of North Carolina at Chapel Hill, USA.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Youngstrom
authors.affiliation: Cleveland Clinic, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Embacher
authors.affiliation: Stanford University, USA.
authors.forename: Antonio Y
authors.initials: AY
authors.lastname: Hardan
authors.affiliation: Washington University in St. Louis, USA.
authors.forename: John N
authors.initials: JN
authors.lastname: Constantino
authors.affiliation: Kennedy Krieger Institute, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Law
authors.affiliation: University Hospitals Case Medical Center, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Findling
authors.affiliation: Cleveland Clinic, USA.
authors.forename: Charis
authors.initials: C
authors.lastname: Eng
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology*; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology / Q000523:psychology*; D002648:Child; D002659:Child Development Disorders, Pervasive / Q000453:epidemiology / Q000523:psychology*; D002675:Child, Preschool; D003142:Communication; D015897:Comorbidity; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008607:Intellectual Disability / Q000453:epidemiology / Q000523:psychology*; D016015:Logistic Models; D008297:Male; D012372:ROC Curve; D012737:Sex Factors; D012919:Social Behavior; D013239:Stereotyped Behavior; D044465:White People
keywords: autism spectrum disorder; autism symptoms; diagnosis; prediction